Most children who wet the bed will outgrow it, and treatment is necessary only if bedwetting is upsetting to the child, according to new guidelines from the Canadian Pediatric Society (CPS).

“In general, bedwetting does not stem from a medical, psychological or emotional problem,” Dr. Mark Feldman, the statement’s lead author, said in a press release. “But it can become a problem if parents, children, or physicians allow themselves to be bothered by it.”

Bedwetting may occur because a child sleeps very deeply, according to Feldman and his colleagues. Ten to 15 percent of 5-year-olds and 6-8 percent of 8-year-olds wet the bed, they note.

Parents hoping to help their children stay dry at night can take the following steps, the CPS states:

-make getting up at night to go to the bathroom a clear goal, and make the toilet easily accessible

-stay away from excess fluids and caffeine-containing foods before bed

-have the child urinate before bedtime

-stop using diapers at night, although training pants may be appropriate

-have the child help clean up the wet bed in the morning “in a nonpunitive manner”

-and “preserve the child’s self-esteem.”

Known scientifically as nocturnal enuresis, bedwetting should not be seen as a possible medical issue unless a child continues to wet the bed at least twice weekly past the age of five, according to the CPS. If bedwetting persists beyond age eight to ten, the group advises, psychological problems such as poor self esteem may be involved, making “reassurance, support, and avoidance of punishment and humiliation” particularly crucial.

The most effective treatment for bedwetting is an alarm device that goes off when the child wets the bed, according to CPS. Although it cures bedwetting less than half the time, the group states, alarms can be helpful for older, motivated children with motivated families when simpler approaches don’t work.

The drug desmopressin is an effective short-term treatment for some children, and may be useful for camp or sleepovers, they add.

Behavioral approaches such as rewards or waking the child to go to the bathroom can be helpful for some children, according to CPS, although they carry the risk of causing poor self-esteem in the child and frustrating the parents.

“The goal of treatment is largely to reduce problems with frustration, conflict and poor self-esteem, and, thus, behavioral therapies for enuresis may do more harm than good,” the CPS concludes.

SOURCE: Pediatrics & Child Health, December 2005.